Pediatric 1

Lecturer : Dr Asma Ahmed

Chapter : 6
Dehydration in Children
 Dehydration
Dehydration is a very common problem encountered in
Both acute and ambulatory care settings.
Children suffer fluid losses from a number of conditions,
including diarrhea caused by gastroenteritis (the most
common cause), fever, losses postoperatively, or a high
urine output due to diabetes insipidus.
Water and electrolytes are lost through urine, stool and
stomach secretions, and insensibly through the skin and
lungs.
 Cont ………………
Whatever the cause, dehydration is a serious and
potentially life-threatening condition, particularly in the
pediatric population.
Children’s bodies have a higher percentage of water content
than adolescents and adults making them more prone to
water and electrolyte loss and rapid fluid shift.
 Cont……………….
Dehydration can be separated into three types:
mild with about 5% loss of pre-illness body weight,
moderate being 10% and severe meaning 15% or more (for
children less than 2 years of age).
For kids greater than 2 years, the percentages are 3, 6, and
9% for mild, moderate and sever dehydration respectfully.
Determining the severity of the child’s state is important for
calculating fluid resuscitation amounts, which will be
explained shortly.
 Cont ……………….
Clinical manifestations usually do not become apparent
until the child is moderately to severely dehydrated, and it is
critical that you are able to identify these upon assessment.
 Cont……………….
The severity of dehydration -i.e. mild, moderate or severe
dehydration - can be determined via signs and symptoms.
A mildly dehydrated child with about a 5% loss in body
weight will be pretty much asymptomatic except for
A decrease in urine output and increased thirst.
With moderate dehydration (i.e. 10% loss), heart rate
increases and blood pressure may be low normal;
remember vital signs changes are a relatively late findings
and are very, very concerning.
 Cont………………
Other signs of moderate dehydration include: decreased
urine output, dry mucous membranes, sunken anterior
fontanel and eyes, decreased skin turgor, decreased tears,
and a prolonged capillary refill time.
 Cont …………………
If the child is severely dehydrated, all of these clinical
manifestations are exacerbated and you will note decreased
BP, tachycardia, poor perfusion, and decreased LOC - all the
typical signs of shock.
The majority of infants and children with 15% dehydration
will need to be managed in an ICU setting.
Loss of body weight can be another useful indicator of
dehydration, however only if combined with other clinical
signs and symptoms, because weight can fluctuate and is
subject to error.
 Use the patient history to discern possible
causes of fluid loss
If an infant is breastfeeding and recently has had poor
intake, or is having diarrhea and/or emesis, expect
hypernatremic dehydration.
A child who is drinking a lot of free water and experiencing
diarrhea would likely have hyponatremic dehydration.
Most children have isotonic dehydration (around 80% and
therefore normal serum sodium values.
 Types of dehydration
according to percentage
 Investigations
Investigations Labs should be drawn on a case by case
basis.
They are generally not helpful unless the child needs
parenteral fluid replacement.
Keep in mind, if you need to start an IV on a child, to avoid a
second poke, think about drawing labs at that time!
 Cont ………………..
Consider the following tests:
Basic Electrolyes:
 Serum sodium concentration- This can indicate whether
dehydration or hyponatremic or hypernatremic.
Serum K- Which may be low due to diarrheal losses or
emesis.
 Cont …………………
 Chloride is also clinically helpful.
For instance, a significantly dehydrated baby with pyloric
stenosis who is obviously having gastric losses including HCL
would be expected to have hypochoremic hypokalemic
metabolic alkalosis.
 Serum bicarbonate is also helpful in noting the degree of
acidosis.
A serum bicarbonate of greater than 17 meq/L is reassuring
that the child is not significantly dehydrated.
 Cont ……………..
 Blood Urea Nitrogen and serum creatinine can be
ordered if there is volume depletion with no renal
insufficiency, expect the B.U.N level to be elevated with little
or no change in creatinine.
 Urinalysis-urine specific gravity is usually elevated if
dehydration is significant Also, dehydration may cause the
presence of hyaline or granular casts, a few white cells and
red cells, and proteinuria.
 Cont ……………….
 Hematocrit and haemoglobin-both will increase in
dehydration due to hemoconcentration.
Also, blood and urine cultures may be indicated if the child
is febrile.
 MANAGEMENT OF DEHYDRATION

For all children with diarrhoea, their hydration

status should be classified as severe dehydration, some
dehydration or no dehydration and appropriate treatment
given.
In a child with diarrhoea, assess the general condition, look
for sunken eyes, make a skin pinch, and offer the child fluid
to see if he or she is thirsty or drinking poorly.
 Types of dehydration
according to management
cont ……………….
Cont ……………….
Cont ………………….
 Cont …………………..
Show the mother how to give ORS solution.
 Give frequent small sips from a cup.
 If the child vomits, wait 10 min, then continue, but more
slowly.
 Continue breastfeeding whenever the child wants.
After 4 h:
 Reassess the child and classify him or her for dehydration.
 Select the appropriate plan to continue treatment.
 Begin feeding the child in the clinic.
 Cont ……………………
If the mother must leave before completing treatment:
 Show her how to prepare ORS solution at home.
 Show her how much ORS to give to fi nish the 4-h
treatment at home.
 Give her enough ORS packets to complete rehydration.
 Explain the four rules of home treatment
 Cont ………………….
Plan A ( No Dehydration)
 Counsel The Mother On The Four Rules Of Home
Treatment:
 Give extra fluid.
 Tell the mother to:
 Breastfeed frequently and for longer at each feed.
 If the child is exclusively breastfed, give ORS or clean
water in addition to breast milk
 If the child is not exclusively breastfed, give one or more
of the following: ORS solution, food-based fl uids (such as
soup, rice water and yoghurt drinks) or clean water.
 Cont …………………
 Show the mother how much fluid to give in addition to
the usual fluid intake:
 ≤ 2 years: 50–100 ml after each loose stool
 ≥ 2 years: 100–200 ml after each loose stool
 Tell the mother to:
 Give frequent small sips from a cup.
 If the child vomits, wait 10 min. Then continue, but more
slowly.
 Continue giving extra fluid until the diarrhoea stops .
 Cont …………………
 Give zinc supplements.
 Tell the mother how much zinc to give:
 ≤ 6 months: half tablet (10 mg) per day for 10–14 days
 ≥ 6 months: one tablet (20 mg) per day for 10–14 days
 Remind the mother to give the zinc supplement for the
full 10–14 days.
 Continue feeding.
 Know when to return to the clinic.